CT of the liver in patients with metastatic breast carcinoma treated by chemotherapy: findings simulating cirrhosis.

Young, Shen; Paulson, Erik K.; Washington, Kimberly; Gulliver, D. J.; Vredenburgh, J. J.; Me, Baker

doi:10.2214/ajr.163.6.7992734

Cited by 110 publications

(101 citation statements)

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“…The most frequently reported cause of pseudocirrhosis is metastatic breast cancer treated with chemotherapy [4][5][6][7][8][9][10][11][12][13][14] , which commonly presents with diffuse nodular changes of the liver surface on ct imaging 15 . However, the liver can also become nodular and resemble cirrhosis after hepatic metastasis in pancreatic, esophageal, and small-cell lung cancer [16][17][18] .…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Because many chemotherapeutic agents (such as tamoxifen, cyclophosphamide, and methotrexate) have been implicated in pseudocirrhosis 4,5,12 , we considered the possibility that treatment effects may have contributed to our patient's liver disease. Although not directly associated with pseudocirrhosis, 5-fluorouracil, oxaliplatin, and sunitinib may cause other adverse events affecting the liver.…”

Section: Toxicities Of Folfox and Sunitinibmentioning

confidence: 99%

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Medullary Thyroid Cancer and Pseudocirrhosis: Case Report and Literature Review

et al. 2012

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and spindle-cell morphologies, and a diagnosis of medullary thyroid carcinoma (mtc) was made.On baseline positron-emission tomography (pet)/ ct imaging, hypodensities corresponding to hypermetabolic foci in both hepatic lobes were observed [ Figure 1 , and cytokeratin 7, but negative for thyroglobulin, cytokeratin 20, and alpha-fetoprotein, which is consistent with mtc metastatic to the liver. At the time of diagnosis, the patient was not taking medications, and she had an unremarkable personal medical history and no family history of thyroid disease, endocrine disorders, or neoplasm.In March 2008, the patient enrolled in a phase i clinical trial (NCT00599924) of 5-fluorouracil (5fu), leucovorin, and oxaliplatin (folfox) in combination with sunitinib, a tyrosine kinase inhibitor with multiple targets, including the vascular endothelial growth factor receptor and the rearranged during transfection (RET) proto-oncogene, which is often upregulated in neuroendocrine tumors such as mtc 1 . The patient received folfox (leucovorin 400 mg/m 2 ; 5-fluorouracil 400 mg/m 2 intravenous bolus, followed by 2400 mg/m 2 infusion over 46 hours; oxaliplatin 85 mg/m 2 ) every 2 weeks and sunitinib 37.5 g daily for 4 weeks, followed by a 2-week rest period. In July 2008, after 4 months of folfox-sunitinib, the patient showed measureable tumor regression in the liver [Figure 1(D)] that qualified as a partial response according to the Response Evaluation Criteria in Solid Tumors. The folfox was discontinued, and the patient was maintained on single-agent sunitinib, which she tolerated well for 15 months with stable liver metastases. The patient underwent serial pet/ ct imaging without intravenous contrast to monitor her disease.In November 2009 (21 months after diagnosis), the patient developed abdominal bloating, early satiety, and right upper quadrant pain that increased with inspiration. Pulmonary exam demonstrated dullness ABSTRACT Pseudocirrhosis is a rare form of liver disease that can cause clinical symptoms and radiographic signs of cirrhosis; however, its histologic features suggest a distinct pathologic process. In the setting of cancer, hepatic metastases and systemic chemotherapy are suspected causes of pseudocirrhosis. Here, we present a patient with medullary thyroid carcinoma metastatic to the liver who developed pseudocirrhosis while on maintenance sunitinib after receiving 5-fluorouracil, leucovorin, and oxaliplatin (folfox) in combination with sunitinib. Cirrhotic change in liver morphology was accompanied by diffusely infiltrative carcinomatous disease resembling the primary tumor. We discuss the diagnosis of pseudocirrhosis in this case and review the literature regarding pseudocirrhosis in cancer. KEY WORDSMedullary thyroid cancer, pseudocirrhosis, carcinomatous cirrhosis CASE DESCRIPTIONA 49-year-old white woman presented in January 2008 with a left-sided cervical mass without associated complaints of neck pain, stridor, dysphonia, dysphagia, malaise, fever, or chills. Physical examination was remarkable for a f...

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Section: Differential Diagnosismentioning

confidence: 99%

Section: Toxicities Of Folfox and Sunitinibmentioning

confidence: 99%

Medullary Thyroid Cancer and Pseudocirrhosis: Case Report and Literature Review

et al. 2012

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“…The imaging features of pseudocirrhosis are similar to those of true cirrhosis (Fig. 3 ) (Young et al 1994 ;Schreiner et al 1998 ). Ascites, splenomegaly, and varices are often present due to associated portal hypertension.…”

Section: Liver Parenchymal Injurymentioning

confidence: 77%

“…At MRI nodules of relatively normal tissue are separated by bands of dense fi brosis that are hypointense on T1-weighted images and hyperintense on T2-weighted images and show delayed gadolinium enhancement. No correlation has been found between specifi c chemotherapy regimens and hepatic contour changes (Young et al 1994 ;Qayyum et al 2007 ).…”

Section: Liver Parenchymal Injurymentioning

confidence: 99%

Female Pelvis: Genital Organs

Forstner

Cunha²

2015

Imaging of Complications and Toxicity Following Tumor Therapy

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Medical Radiology-Diagnostic Imaging is a unique series that aims to document the most innovative technologies in all fi elds within diagnostic imaging and interventional radiology, thereby informing the physician in practice of the latest advances in diagnostic imaging and percutaneous imageguided minimally invasive procedures. Th e contents are intended to cover all organs, and all modern imaging techniques and image-guided treatment modalities, with special emphasis on applications in clinical practice. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. Medical Radiology -Radiation Oncology is a unique series that aims to document the most innovative technologies in all fi elds within radiology, thereby informing the physician in practice of the latest advances in diagnostic and treatment techniques. Th e contents range from contemporary statements relating to management for various disease sites to explanations of the newest techniques for tumor identifi cation and of mechanisms for the enhancement of radiation eff ects, with the emphasis on maximizing cure and minimizing complications. Each volume is a comprehensive reference book on a topical theme, and the editors are always experts of high international standing. Contributions are included from both clinicians and researchers, ensuring wide appeal. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. AbstractA precise knowledge of antineoplastic drugs is an indispensable basis for the care of patients with cancer. The mechanisms of action and resistance, cross-resistance patterns, pharmacodynamics and pharmacokinetics, pharmacological interaction, and last but not least potential adverse effects should be part of this knowledge. As contemporary cancer care requires interdisciplinary and multiprofessional structures, the radiologist is an important a...

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“…Another common sign, seen mainly but not exclusively in breast cancer, is pseudo cirrhosis of the liver due to rapid reduction in extensive liver metastases (figure 10) 60 . 5: "Pseudo-pseudo-progression": This is our new term for an incorrect assumption of disease progression on treatment, due to a mismatch between scan timings and actual treatment dates.…”

Section: The Hilar and Mediastinal Lymphadenopathy Resolved (A1 And Bmentioning

confidence: 99%

Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer

2016

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Radiological error is inevitable and usually multifactorial. Error can be secondary to radiologist specific causes, including cognitive and perceptive errors or ambiguity of report, or system related causes, including inadequate, misleading or incorrect clinical information, poor imaging technique, excessive workload and poor working conditions.In this paper, we discuss a systematic approach to reduce errors in oncological radiology reporting, thus reducing risk to the patient. Rather than attempt to discuss all types of error we concentrate on the most important and commonly occurring errors that we have encountered over 20 years of practice, based on a weekly discrepancy reviews of our practice and independent reviews of clinical and research imaging from other institutions. This review focuses on CT scan reporting for staging, surveillance and response assessment of cancer patients, but the messages apply to all imaging modalities.

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CT of the liver in patients with metastatic breast carcinoma treated by chemotherapy: findings simulating cirrhosis.

Cited by 110 publications

References 0 publications

Medullary Thyroid Cancer and Pseudocirrhosis: Case Report and Literature Review

Medullary Thyroid Cancer and Pseudocirrhosis: Case Report and Literature Review

Female Pelvis: Genital Organs

Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer

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